Sexual dysfunction in chronic hepatitis B: a comprehensive review of pathophysiology, clinical burden, and integrated...

Chronic hepatitis B (CHB) affects approximately 240 million people worldwide. Advances in antiviral therapy have shifted CHB management toward long-term, multidimensional care, in which sexual health is closely linked to psychological wellbeing, intimate relationships, and patient-clinician communication. However, sexual dysfunction (SD) in CHB remains insufficiently characterized and is not yet routinely integrated into clinical management. This narrative review synthesizes evidence focused on CHB regarding the epidemiology, clinical burden, pathophysiological mechanisms, and antiviral treatment implications of SD across disease stages and treatment contexts. Reported prevalence estimates vary widely, ranging from 8.6 to 63.1% across heterogeneous HBV-related studies. Mechanistically, SD in CHB appears to reflect interactions among biological vulnerability, psychological stressors, and lifestyle determinants. Evidence on treatment effects remains limited, but available data do not indicate a consistent adverse effect of nucleos(t)ide analogues on sexual function, whereas interferon-based regimens may indirectly contribute to SD through fatigue and neuropsychiatric symptoms. Accordingly, we propose an integrated management framework comprising proactive screening, multidimensional assessment, individualized intervention, and longitudinal monitoring. In practice, this framework emphasizes validated sexual function instruments, concurrent assessment of psychological distress, transmission concerns, closer monitoring of patients at higher risk, targeted symptom management, and coordinated multidisciplinary support when needed. Future research should prioritize prospective longitudinal studies, sex-specific analyses, standardized sexual function instruments, and inclusion of sexual health as a patient-reported endpoint in antiviral therapy trials to better define the burden, mechanisms, and management of SD in CHB.